Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Can we measure what it takes to be a good doctor?

Ashish Jha, MD, MPH
Physician
March 28, 2014
337 Shares
Share
Tweet
Share

I recently spoke to a quality measures development organization and it got me thinking — what makes a good doctor, and how do we measure it?

In thinking about this, I reflected on how far we have come on quality measurement.  A decade or so ago, many physicians didn’t think the quality of their care could be measured and any attempt to do so was “bean counting” folly at best or destructive and dangerous at worse.  Yet, in the last decade, we have seen a sea change.  We have developed hundreds of quality measures and physicians are grumblingly accepting that quality measurement is here to stay.

But the unease with quality measurement has not gone away and here’s why.  If you ask “quality experts” what good care looks like for a patient with diabetes, they might apply the following criteria:  good hemoglobin A1C control, regular checking of cholesterol, effective LDL control, smoking cessation counseling, and use of an ACE inhibitor or ARB in subsets of patients with diabetes.  Yet, when I think about great clinicians that I know — do I ask myself who achieves the best hemoglobin A1C control? No. Those measures — all evidence-based, all closely tied to better patient outcomes — don’t really feel like they measure the quality of the physician.

So where’s the disconnect?  What does make a good doctor?  Unsure, I asked Twitter:

good-doctor-twitter

Over 200 answers came rolling in.  Listed below are the top 10.  Top answer? Having empathy. #2? Being a good listener.  It wasn’t until we get to #5 that we see “competent/effective.”

good-doctor-twitter-results

Even though the survey results above come from those I interact with on Twitter, I suspect the results reflect what most Americans would want. As I read the discussions that followed, I came to conclude one thing:  Most people assume that physicians meet a threshold of intelligence, knowledge, and judgment and therefore, what differentiates good doctors from mediocre ones is the “soft” stuff.

It’s an interesting set of assumptions, but is it true?  It is, at least somewhat.  Most American physicians meet a basic threshold of competence — our system of licensure, board exams, etc. ensure that a vast majority of physicians have at least a basic level of knowledge.  What most people don’t appreciate, however, is that even among this group, there are large, meaningful variations in capability and clinical judgment.

And, of course, a small minority of people are able to get licensed without meeting the threshold at all.  We all know these physicians — a small number to be sure — that are dangerously ineffective.  We, the medical community, have been terrible about singling these physicians out and asking them to get better — or leave the profession.

In the Twitter discussion, there was a second point raised by John Birkmeyer and that was likely on the minds of many respondents.  He said “I’d want different things from my PCP and heart surgeon. Humility. Overrated for the latter.” John was raising a key distinction between what we want out of a physician (an internist or a family practitioner) versus a surgeon.  Yes, in order to be “good,” humility and empathy are important, even for cardiac surgeons. But when they are cutting into your sternum?  You want them to be technically proficient and that trait trumps their ability (or lack thereof) to be empathic. Surgeons’ empathy and kindness matter — but it may not be as critical to their being an effective surgeon as their technical and team management skills. For internists, effectiveness is much more dependent on their ability to listen, be empathic, and take patients’ values into consideration.

A final point.  My favorite tweet came from Farzad Mostashari, who asked, “If your doctor doesn’t use the best data available to them to take care of you, do they really care about you?” In all the discussions about being a good doctor, we heard little about effective use of beta-blockers for heart disease, or good management of diabetes care.  That’s the stuff we measure, and it’s important. We use them as part of the Physician Quality Reporting System (PQRS).  But I’m not sure they really measure the quality of the physician.  They measure quality of the system in which the physician practices.  You can have a mediocre physician, but on a good team with excellent clinical support staff, those things get done.  Even the smartest physician who knows the evidence perfectly can’t deliver consistently reliable care if there isn’t a system built around him or her to do so.

So, when it comes to thinking about ambulatory care quality — we should think about two sets of metrics: What it means to be a good doctor and what it means to work in a good system.  In measuring doctor quality, we might focus on “soft” skills like empathy, which we can measure through patient experience surveys.  But we also have to focus on intellectual skills, such as ability to make difficult diagnoses and emotional intelligence, such as the ability to collaborate and effectively lead teams — and we don’t really measure these things at all, erroneously assuming that all clinicians have them.

For measuring good systems, we could use our current metrics such as whether they achieve good hypertension and diabetes control.  We need to keep these two sets of metrics separate and not confuse one for the other. And, alas, for surgeons, we need a different approach yet.  Yes, I still believe that humility and empathy go a long way — but these qualities are no substitute for sound judgment and a steady hand.

Ashish Jha is an associate professor of health policy and management, Harvard School of Public Health, Boston, MA.  He blogs at An Ounce of Evidence and can be found on Twitter @ashishkjha.

Prev

Assure patients that we are on their side

March 28, 2014 Kevin 1
…
Next

Is acetaminophen taken during pregnancy associated with ADHD?

March 28, 2014 Kevin 0
…

Tagged as: Primary Care, Surgery

Post navigation

< Previous Post
Assure patients that we are on their side
Next Post >
Is acetaminophen taken during pregnancy associated with ADHD?

More by Ashish Jha, MD, MPH

  • Ranking the world’s health systems: These results may surprise you

    Ashish Jha, MD, MPH
  • How much does it matter which hospital you go to?

    Ashish Jha, MD, MPH
  • Men and women doctors versus correlation and causation

    Ashish Jha, MD, MPH

More in Physician

  • Finding your ideal work-life balance: tips for prioritizing personal life and achieving professional success

    Zahid Awan, MD
  • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

    Harvey Castro, MD, MBA
  • 7 ways to beat burnout: a guide for health care professionals to reduce stress and reclaim their passion

    Marie Livesey, DO
  • Heartwarming stories of cancer patients teaching us about life and the human spirit

    Johnathan Yao, MD, MPH
  • We need a new Hippocratic Oath that puts patient autonomy first

    Jeffrey A. Singer, MD
  • The meaning of death in medicine: the role of compassionate care in end-of-life patient care

    Ton La, Jr., MD, JD
  • Most Popular

  • Past Week

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nose-brain connection: The surprising link between allergies and mental health revealed

      Kara Wada, MD | Conditions
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Urgent innovation needed to address growing mental health crisis among children and families

      Monika Roots, MD | Conditions
    • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

      Cheryl Lazarus | Conditions
    • Medical errors and the power of apologies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding your ideal work-life balance: tips for prioritizing personal life and achieving professional success

      Zahid Awan, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • 7 ways to beat burnout: a guide for health care professionals to reduce stress and reclaim their passion

      Marie Livesey, DO | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 7 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Missing Doctor's Gunshot Wound; COVID Funds Reshuffled; Helpline Chatbot Shut Down
  • Second RSV Vaccine Lands Approval for Older Adults
  • Long COVID Cognitive, Depressive Symptoms Tied to Brain Inflammation Marker
  • 'Practice Changing' Trial on Activity Recs After Prolapse Surgery
  • What's With the Buzz Around NAD+ Injections?

Meeting Coverage

  • Tenapanor Improves Abdominal Symptoms in Patients With IBS-C
  • Benefits Found for Hand OA Drug Treatments
  • MRI-Based Screening May Detect Prostate Cancer Earlier
  • New Model Aims to Study Intestinal Fibrosis in Crohn's Disease
  • Hypertension Tied to Worse Survival After Surgery for Upper Tract Urothelial Cancers
  • Most Popular

  • Past Week

    • The power of coaching for physicians: transforming thoughts, changing lives

      Kim Downey, PT | Conditions
    • The hidden factor in physician burnout: How the climate crisis is contributing to the erosion of well-being

      Elizabeth Cerceo, MD | Physician
    • Why affirmative action is crucial for health equity and social justice in medicine

      Katrina Gipson, MD, MPH | Policy
    • Unlocking the secrets of cancer conferences: an end-of-life counselor’s journey among pharmaceutical giants

      Althea Halchuck, EJD | Conditions
    • Why doctors aren’t to blame for the U.S. opioid crisis [PODCAST]

      The Podcast by KevinMD | Podcast
    • Nose-brain connection: The surprising link between allergies and mental health revealed

      Kara Wada, MD | Conditions
  • Past 6 Months

    • It’s time to replace the 0 to 10 pain intensity scale with a better measure

      Mark Sullivan, MD and Jane Ballantyne, MD | Conditions
    • “Is your surgeon really skilled? The hidden threat to public safety in medicine.

      Gene Uzawa Dorio, MD | Physician
    • Breaking point: the 5 reasons American doctors are dreaming of walking away from medicine

      Amol Shrikhande, MD | Physician
    • Revolutionize your practice: the value-based care model that reduces physician burnout

      Chandravadan Patel, MD | Physician
    • Unveiling the hidden damage: the secretive world of medical boards

      Alan Lindemann, MD | Physician
    • Breaking the cycle of racism in health care: a call for anti-racist action

      Tomi Mitchell, MD | Policy
  • Recent Posts

    • Urgent innovation needed to address growing mental health crisis among children and families

      Monika Roots, MD | Conditions
    • The importance of listening in health care: a mother’s journey advocating for children with chronic Lyme disease

      Cheryl Lazarus | Conditions
    • Medical errors and the power of apologies [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding your ideal work-life balance: tips for prioritizing personal life and achieving professional success

      Zahid Awan, MD | Physician
    • Boxing legends Tyson and Foreman: powerful lessons for a resilient and evolving health care future

      Harvey Castro, MD, MBA | Physician
    • 7 ways to beat burnout: a guide for health care professionals to reduce stress and reclaim their passion

      Marie Livesey, DO | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Can we measure what it takes to be a good doctor?
7 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...